Connections Community Support Programs (CCSP), a Delaware operator of community clinics, agreed to shell out an estimated $15 million to settle fraud allegations over mental health and substance use disorder (SUD) treatment services back in August of 2021.
According to the U.S. Department of Justice (DOJ), CCSP agreed to settle claims that it violated the False Claims Act, which forbids establishments that lack personal with professional credentials under federal insurance guidelines to bill for mental health services. Non-qualified professionals were performing mental health services, CCSP was receiving higher payments than legally allowed due to billing using incorrect procedure codes, and the list went on.
It was a scam.
Treatment centers like CCSP falsely claim to be a dual diagnosis and true mental health facility because it’s easier to bill insurance companies for mental health care than substance abuse.
Falsely claiming a dual diagnosis center is another example of how corrupt the recovery industry has become.
Now, there are treatment centers like the one in Deleware administering improper mental health care to patients who really need it, just for that insurance premium. And the scams don’t stop there. From body brokering and waiving deductions, the transformative and holistic experience that is supposed to be addiction recovery is now a system of insurance fraud, patient enticement, listing theft, and a host of many other schemes aimed at taking advantage of how profitable the field has become.
This isn’t to scare you; this is to inform you. This isn’t to attack competitors; this is an effort to hold the recovery industry accountable. Most importantly, this is so you or your loved one can get the right treatment, the right way.
I. What Does ‘Dual Diagnosis’ Mean?
Here’s the definition from MedlinePlus: “A person with a dual diagnosis has both a mental disorder and an alcohol or drug problem. These conditions occur together frequently. About half of people who have a mental disorder will also have a substance use disorder at some point in their lives and vice versa. The interactions of the two conditions can worsen both.”
According to the National Institute on Drug Abuse (NIDA), individuals diagnosed with mood or anxiety disorders are about twice as likely to struggle with substance use disorder. Similarly, those who struggle with substance use disorder are about twice as likely to develop a mood or anxiety disorder.
Patients in the process of recovery will often seek mental health care after these common symptoms:
- Relationship problems
- Chronic grief
According to statistics updated on May 15, 2021, from the internet forum Dual Diagnosis, co-occurring mental health conditions and substance use disorders affect around 45% of American adults. However, only six percent of Americans with a substance use disorder and mental health disorder received mental health treatment, two percent received treatment solely for a substance use disorder, and 12% received dual diagnosis treatment.
The stats are disproportionate because only recently studies have surfaced revealing patients could be dealing with two diagnoses, as mental health treatment and addiction treatment have historically been separated systems of care.
Research shows there are three possible reasons behind co-occurring disorders:
- Overlapping Risk Factors: SUDs and other mental health issues share risk factors, like childhood trauma and genetic factors.
- Self-Medicating: Individuals who have mental illness often seek ways to alleviate the symptoms. While the numbness of substance use might work as a temporary fix, it exacerbates symptoms in both the short and long term.
- Drug-Induced Brain Changes: Mental health disorders interact with SUDs because drugs alter the structure of your brain. The areas of the brain affected by substance use are correlated with areas also associated with impulse-control, mood, and anxiety disorders.
Almost every treatment center claims to treat mental health disorders and be a dual diagnosis facility. However, only a few drug treatment centers specialize in treating complex co-occurring disorders. According to the forum Dual Diagnosis, “the number of facilities providing dual diagnosis treatment programs increased by four percent over a six-year period. However, only 16% of all substance abuse treatment facilities have specialized mental health treatment to provide adequate care to dual diagnosis patients.”
As a result, a lot of these facilities aren’t actually providing the adequate care that people with co-occurring mental health disorders need. So, why are they doing it?
II. Why Do Facilities Falsely Claim to Treat Dual Diagnosis?
Facilities will falsely claim to treat dual diagnosis because it’s easier to bill insurance companies for mental health care than substance abuse treatment.
Although the Affordable Care Act (ACA) made it so that insurance providers would accept both mental health and substance use disorders, mental health is more likely to be approved for a client. In turn, mental health and addiction treatment became less stigmatized. On the other hand, insurance companies may still make it difficult for those suffering from addiction to receive the help they need, and facilities use that to their advantage.
Unfortunately, insurance companies are “behind” on what substance abuse treatment entails. For example, an individual may be using methamphetamine but be denied treatment coverage for certain levels of care, such as detox, because of the outdated idea that the drug doesn’t require medical attention. However, if a treatment facility were to present an insurance company with co-occurring methamphetamine addiction and mental health disorders, the individual would more likely be approved for treatment coverage.
The $15 million dollar payout (CCSP) was forced to settle is only one example of the lengths these treatment facilities will go in order to tap into a client’s insurance money.
Similarly, an inpatient drug treatment center based in New York City called Addiction Care Interventions (ACI) was forced to settle in a fraudulent Medicaid billing scheme. While they provide substance use disorder (SUD) treatment services, they were found to have forged signatures from medical providers to make it look like patients had received evaluations from health care professionals when they had not.
Many of these recovery and treatment center scams complement each other, too. For example, they’re not only being deceitful about the treatment they’re performing in false claims but make sure they get patients by bribing (waiving deductibles) and recruiting (body brokering).
It’s a money-focused approach, and the patients suffer the most.
III. Why Are False Treatment Claims Harmful?
Beyond the legal implications, false claiming is wrong because it ultimately harms you or your loved one. If you or your loved one has a dual diagnosis, it is crucial to be especially aware of the institutions eager to claim behavioral health insurance.
Administering improper treatment to a mental health client in need can lead to causing more harm than good. For example, many of these facilities falsely claiming to have behavioral therapy treatment will offer EMDR as a therapy option.
EMDR is a therapy practice that activates the natural healing powers of the brain by reconnecting the client, in a safe and measured way, back to the emotions associated with that traumatic event for resolution.
However, EMDR is a process that takes time and cannot always be completed in a 30-day treatment stay. Some people may not also be ready to start trauma work in their first 30 days of sobriety. Going from cutting substances out of your life directly into intense trauma work can re-traumatize a client when a facility doesn’t have the proper staffing for EMDR therapy. If a facility does not provide the adequate aftercare needs for an individual, they run the risk of leaving treatment and relapsing due to the intense feelings brought up by EMDR.
Understanding false claims through real-life scenarios gives an honest look at how these schemes can go down, but understanding the law they’re breaking makes the perspective come fill circle.
IV. Dual Diagnosis and the Law
There’s no better way to comprehend what dual diagnosis is and how you or a loved one can best navigate the recovery industry with it than studying the law surrounding it. Here are a few laws that involve dual diagnosis.
- False Claims: Originally enacted in 1863 in response to defense contractor fraud during the American Civil War, the False Claims Act (FCA) mandates that anyone who knowingly submitted false claims to the government was liable for double the government’s damages plus a penalty of $2,000 for each false claim. The FCA also allows “qui tam” suits, which is when private citizens file on behalf of the government. Successful qui tams sometimes result in a reward of the government’s recovery. A good portion of fraud section investigations and lawsuits are qui tam actions.
- The Mental Health Parity and Addiction Equity Act (MHPAEA): This act requires providers to offer mental health and substance abuse benefits on substantially the same terms as they provide medical and surgical benefits. Furthermore, health plans offering both are mandated to have a detailed analysis on-hand to show how they meet these requirements. Signed in 2008, the act originally only applied to group health insurance coverage but was extended into individual health insurance coverage by the ACA in 2010.
IV. Protecting You or Your Loved One
Ask the Right Questions
Treating co-occurring disorders simultaneously is crucial to the success of treatment. When only one disorder is treated at a time, it can increase the risk of relapse for both conditions. For example, only treating substance use disorder and not co-occurring mental health disorders often leaves an individual still in distress after treatment.
While the client may no longer be using drugs or alcohol, they will still experience symptoms of their mental health disorder, especially if they have not had adequate therapy, necessary medications, or been taught coping skills. Once they leave treatment, they may experience symptoms of their mental illness that they don’t know how to deal with and that feels debilitating. As a result, they may turn back to drugs or alcohol to cope.
Doing your research into a facility and what adequate dual diagnosis care looks like can help you and your family find the proper treatment for co-occurring disorders. However, it can be challenging to know what questions to ask a facility if you aren’t 100% sure what proper dual diagnosis looks like.
Some questions you may ask a facility include:
What does your staffing look like?
Unfortunately, despite claims of being a dual diagnosis facility, some treatment centers are not adequately equipped to treat individuals with co-occurring disorders. One of the tell-tale signs of inadequate dual diagnosis treatment is a lack of staff.
When looking for adequate dual diagnosis care, it’s crucial to ask what staffing looks like at a facility. Facilities with in-house psychiatric staff and a mental health focus will be equipped to help people with co-occurring disorders.
Does the dual diagnosis center treat addiction and mental health issues concurrently?
Be exact with this line of questioning. Many treatment facilities do not treat both. While they may not be honest, it will allow you to ask a follow-up question on the level of experience and credentials their mental health care workers have as well as the treatment plans.
Is dual diagnosis treatment integrated?
Integrated treatment is essential when treating individuals with co-occurring disorders. A few key highlights of integrated treatment you should ask a facility about include:
- How extensive is the program?
- Do you implement various psychotherapeutic interventions?
- Do you help individuals look for solutions for long-term recovery?
- Do you help clients find a community outside of treatment?
- Are clients included in the decision-making process of their care?
What does the treatment plan for dual diagnosis look like?
Dual diagnosis programs can look a variety of ways, as they’re combinations of addiction recovery and mental health treatments. This could be a standard 12-Step approach common in addiction programs or psychotherapy treatments, trauma work, and group therapy. Your treatment could even involve your family, friends, and other loved ones who can assist you. Make sure you ask what kind of treatment plan they offer and make sure it best fits the needs of you or your loved one.
How long does treatment last? Does the facility provide adequate aftercare options?
The typical 30-day treatment program can work for addressing co-occurring disorders. However, when an individual only stays in treatment for 30 days, it is crucial they receive the necessary aftercare to continue recovery. Dual diagnosis can often take longer than 30 days to address due to the complexity of mental health symptoms a person may be experiencing. It is crucial a client is set up with continuing care, such as an outpatient treatment option, continuing therapy, or community support.
Asking how long a treatment center keeps dual diagnosis patients can help inform you or your loved ones of the best option for you. If you feel an individual needs longer than 30 days, ask a facility about their options; some people may benefit from a 60 or 90-day stay.
Programs specializing in long-term treatment can give individuals the best opportunity to establish successful recovery and reap the benefits of full continuums of care. The full continuum of care provides individuals safe environments in which to demonstrate their newly learned skills.
Does the dual diagnosis center offer care by a diverse staff of professionals?
Treatment is not packaged one way. You’re going to want a licensed, certified, and experienced team that includes everything you’ll need from psychologists and dieticians to unique treatment options like music therapy.
What type of license, certification, or accreditation does the program have?
Again, while these questions may seem obvious, it’s going to show that you’re not someone to be messed around with. When you ask if the dual diagnosis center is licensed or certified by the state, they have no choice but to give you an answer that you can cross-reference.
Here at White House Recovery and Detox, we believe that recovery facilities should be completely transparent. Exposing the industry is exposing ourselves, and we hope you look into our practices as much as we encourage you to look into other treatment facilities. If you’re not in the hands of someone who views you or a loved one as more than a way to make money, none of their treatment practices matter. False claims are a serious pitfall when getting into the business of recovery, and we want you to be read up so as to best know how to navigate those waters. From the understanding of the term, why the scam loophole exists, and the factors that enable it to examples of false claims in real life, we want you to be ahead of the game when it comes to this gimmick that has become prevalent in the recovery industry. Call us at (800) 510-5393.